American Heart Assoc. Recommends Cardiac Screening in Pediatric ADHD patients
On April 21, 2008, the American Heart Association released a statement recommending screening for children for cardiac conditions before and during treatment with stimulant drugs for ADHD. The AHA recommends using heart rate and blood pressure checks and screening for conditions with related cardiac symptoms before prescribing stimulant drugs for ADHD. It also recommends that each child diagnosed with ADHD be given an electrocardiogram before these drugs are prescribed. These medications can cause an increase in blood pressure and heart rate. For most children, this is not a problem. But in those children with heart conditions, it could make them more vulnerable to cardiac arrest-an erratic heartbeat that causes the heart to stop pumping blood through the body-and other heart problems.
The current AAP treatment guideline does not contain specific recommendations for cardiac screening or frequency of heart rate and blood pressure monitoring for these patients. It does more broadly recommend monitoring these patients for known side effects of the particular drugs they are taking. The AAP is currently revising its diagnosis and treatment guidelines for ADHD, and will be reviewing new science and case reports related to both cardiology and drug safety.
If you have concerns regarding your child or would like to have an electrocardiogram done for your child on ADHD medications, please follow up with your provider. Currently your child's heart health is evaluated at their yearly physical exam and at their three month ADD/ADHD follow-ups.
UPDATE: (JUNE 2011) FEW CARDIOVASCULAR EVENTS SEEN IN CHILDREN AND TEENS TAKING ADHD MEDS
In a large study, children and teens taking prescription medications for attention deficit hyperactivity disorder (ADHD) had few cardiovascular events, and in general had no more than children who were not exposed to the drugs. The study, "Severe Cardiovascular Events and Death in Children and Adolescents Exposed to Attention Deficit Hyperactivity Disorder Medications,” will appear in the June 2011 issue of Pediatrics (published online on Monday, May 16). Researchers looked at data on more than 241,000 users of ADHD medications aged 3 to 17 and more than 965,000 nonusers. They observed no statistically significant difference between users and nonusers in the rate of validated sudden death or ventricular arrhythmia (irregular heartbeat). No myocardial infarctions (heart attacks) were identified in the medication users. Although there were 142 hospital claims for stroke across the two groups, none of these could be validated in follow-up with the hospitals. Because the incidence of cardiovascular events was so low in the study group, it is not possible for the authors to completely rule out an association between these medications and increased rates of these events.
June issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).
4/2011:
The U.S. drugs regulator said it was not recommending changes in the use of stimulants such as Adderall XR and Ritalin to treat hyperactivity, after a review of a study into potential heart disease risks from the drugs.
"At this time, FDA is not recommending any changes to the drug labels and or use of these medications," the U.S. Food and Drug Administration said on its website.
The FDA said it would give a full update after the final analyses on the potential impact of stimulant ADHD drugs on the risk of heart disease and strokes were evaluated.
The American Academy of Pediatrics reviewed the recommendation by the American Heart Association and is making the following conclusions and recommendations.
Although the death of a child is a tragedy, there are no studies or compelling clinical evidence demonstrating that the likelihood of sudden death is higher in children receiving medications for ADHD than the general population.
A recommendation to obtain routine ECGs for children receiving ADHD medications is not warranted.
The AAP does not recommend the routine use of ECGs before initiating stimulant therapy for ADHD.
The AAP continues to recommend a careful assessment of all children, including those starting stimulants, using a targeted cardiac history and a physical examination, including a careful cardiac examination.
Given current evidence, the AAP encourages primary care and subspecialty physicians to continue currently recommended treatment for ADHD, including stimulant medications, without obtaining routine ECGs or routine subspecialty cardiology evaluation for most children before starting therapy with these medications.
The AAP urges further research on risk factors for Sudden Cardiac Death among all children and adolescents, including those with ADHD treated with stimulant medications. Improved methods to detect children with hidden cardiac disease should be another focus of such research efforts.